Murat Gunaydin

Weil's Disease: Report of 12 Cases

The epidemiological distribution and clinical features of 12 cases of Weils disease from Turkey, are reviewed. The disease is most common in male farmers from rural areas. Myalgia and jaundice were recorded in all patients. Signs included vomiting in 9 patients, haemorrhages in 6, and renal function was impaired in 6. Creatine phosphokinase levels were found above normal limits in 75% of the cases. Leptospires were demonstrated with dark-field microscopy in the blood of 9 and in the urine of 5 of these patients. The diagnosis was confirmed with microscopic agglutination test (MAT) as well as with ELISA. Ig M antibodies were detected in 11 (92%) of the patients and is an accurate marker for acute leptospirosis. Penicillin was used for therapy and the outcome was favorable in 10 patients. Two patients died. It should be kept in mind that leptospirosis is an extremely severe disease which requires appropriate examinations at the right moment.

Serotypes of Streptococcus pneumoniae Isolates from Children with Invasive Pneumococcal Disease in Turkey: Baseline Evaluation of the Introduction of the Pneumococcal Conjugate Vaccine Nationwide

ABSTRACT Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children ≤2 years of age, the potential coverage rate of PCV7 was 69.5%. The most frequent non-PCV7 serotypes were 19A, 3, 1, 6A, and 8.

Investigation of diagnostic potentials of nine different biomarkers in endometriosis.

OBJECTIVE To investigate the diagnostic potentials of the serum levels of nine different biomarkers in endometriosis. STUDY DESIGN In this case-controlled, prospective clinical study, 80 women underwent laparoscopy or laparotomy with a preliminary diagnosis of chronic pelvic pain, severe secondary dysmenorrhea, infertility, pelvic endometriosis or pelvic mass. The 60 women with confirmed pelvic endometriosis constituted the endometriosis group, and the other 20 women without endometriosis constituted the control group. Preoperative blood samples were obtained for serum biomarker measurements. Serum levels of nine different serum biomarkers including α-enolase, macrophage migration inhibitory factor, leptin, interleukin-8, anti-endometrial antibody, phosphoinositide dependent protein kinase 1, CA125, syntaxin-5, and laminin-1 were measured concurrently and compared between the control and endometriosis groups, and among control group and endometriosis subgroups including stage I, stage II, stage III and stage IV endometriosis. RESULTS The serum levels of α-enolase, macrophage migration inhibitory factor, leptin, interleukin-8 and antiendometrial antibodies showed a statistically significant difference neither between control and endometriosis groups nor among control group and endometriosis subgroups. The serum levels of CA125, syntaxin-5 and laminin-1 showed a statistically significant difference both between the control and endometriosis groups (p<0.01) and among control group and endometriosis subgroups (p<0.01). Serum levels of laminin-1 in stage II and IV endometriosis; syntaxin-5 in stage I and II endometriosis; and CA125 in stage III and IV endometriosis were found to have the different levels compared to control group. CONCLUSIONS These findings show that the concurrent measurement of CA125, syntaxin-5 and laminin-1 might be a useful non-invasive test in strengthening the diagnosis of endometriosis and in predicting its severity.

Distribution of nontuberculous Mycobacteria strains.

AimMycobacteria other than tuberculosis (MOTT) cause increasingly serious infections especially in immunosuppressive patients by direct transmission from the environment or after colonization. However, identification of these species is difficult because of the cost and difficulties in defining to species level. Identification and distribution of these species can help clinician in the choice of treatment.Materials and methodsA total of 90 MOTT strains obtained from four different centers were included in the study. These strains were identified by sequence analysis of 16S rRNA and Hsp65 genetic regions.ResultsAccordingly, within the 90 MOTT strains, 17 different species were identified. In order of frequency, these species were M. gordonea (n = 21), M. abscessus (n = 13), M. lentiflavum (n = 9), M. fortuitum (n = 8), M. intracellulare (n = 6), M. kumamotonense (n = 6), M. neoaurum (n = 5), M. chimaera (n = 5), M. alvei (n = 5), M. peregrinum (n = 3), M. canariasense (n = 3), M. flavescens (n = 1), M. mucogenicum (n = 1), M. chelona (n = 1), M. elephantis (n = 1), M. terrae (n = 1) and M. xenopi (n = 1). Most frequently identified MOTT species according to the geographical origin were as follows: M. abscessus was the most common species either in Istanbul or Malatya regions (n = 6, n = 6, consequently). While M. kumamotonense was the most frequent species isolated from Ankara region (n = 6), M. gordonea was the most common for Samsun region (n = 14).ConclusionOur study revealed that frequency of MOTT varies depending on the number of clinical samples and that frequency of these species were affected by the newly identified species as a result of the use of novel molecular methods. In conclusion, when establishing diagnosis and treatment methods, it is important to know that infections caused by unidentified MOTT species may vary according to the regions in Turkey. The results of the study showed that there were differences in the frequency of MOTT species in the different geographical regions of Turkey.

Serotypes of Streptococcus pneumoniae Isolates of Children with Invasive Pneumococcal Disease in Turkey: A Baseline Evaluation of the National Introduction of the Pneumococcal Conjugate Vaccine

ABSTRACT Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children ≤2 years of age, the potential coverage rate of PCV7 was 69.5%. The most frequent non-PCV7 serotypes were 19A, 3, 1, 6A, and 8.

Results from the Survey of Antibiotic Resistance (SOAR) 2011–13 in Turkey

OBJECTIVES Data are presented from the Survey of Antibiotic Resistance (SOAR) for respiratory tract infection pathogens collected in 2011-13 from Turkey. METHODS MICs were determined using Etest(®). Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) interpretive criteria. RESULTS Rates of antibiotic susceptibility were very low among 333 isolates of Streptococcus pneumoniae tested: penicillin 38% using CLSI (oral) and EUCAST breakpoints; erythromycin 51% using CLSI and EUCAST criteria; and cefuroxime 64.6% using CLSI and PK/PD and 46.9% using EUCAST. Of the isolates, >90% were susceptible to amoxicillin/clavulanic acid, ceftriaxone (except using EUCAST criteria: 76%), levofloxacin and high-dose intravenous penicillin. Among 339 Haemophilus influenzae isolates, 6.8% were β-lactamase positive while 9.1% were β-lactamase negative but ampicillin resistant (BLNAR) by CLSI (14.7% by EUCAST) criteria. Amoxicillin/clavulanic acid susceptibility was ∼90% by CLSI (with or without BLNAR adjustment, EUCAST and high-dose PK/PD) but lower, at 82.9%, by EUCAST with BLNAR adjustment. Levofloxacin susceptibility was 96% using all three breakpoints. Dramatic differences in rates of susceptibility, depending on the breakpoints used, were seen for cefaclor [94% by CLSI (86.4% BLNAR adjusted), 23% by PK/PD] and cefuroxime [97% by CLSI (89.1% BLNAR adjusted), 85% by PK/PD, 15% by EUCAST (13.0% BLNAR adjusted)]. Streptococcus pyogenes (n = 222) and Moraxella catarrhalis (n = 40) isolates remained highly susceptible to amoxicillin/clavulanic acid, cephalosporins and levofloxacin, with only erythromycin susceptibility dropping below 95% for S. pyogenes. CONCLUSIONS Overall, amoxicillin/clavulanic acid and levofloxacin were the most active antibiotics based on all three breakpoints against these pathogens. Although susceptibility was not universally low in Turkey, high resistance rates were found in S. pneumoniae and, when using PK/PD and EUCAST breakpoints, in other respiratory pathogens.

Is Serum Cystatin C a Better Marker than Serum Creatinine for Monitoring Renal Function in Pediatric Intensive Care Unit

In critically ill patients, mild to moderate reductions in glomerular filtration rate are not instantly followed by parallel changes in serum creatinine (SCr). The aim of this study was to identify a value of serum cystatin C (cys-C) level as a marker for monitoring renal function in critically ill pediatric patients. Creatinine clearance was used to estimate glomeruler filtration rate (eGFR). The correlation between the inverse of serum cys-C and eGFR (r = -0.70, p < 0.0001) was better than the correlation between the inverse of SCr and eGFR (r = -0.27, p = 0.008). Serum cys-C was found to be superior to SCr to predict renal impairment (area under the curve for cys-C, 0.932 and for SCr, 0.658). It can be concluded that cys-C is superior to SCr for the detection of renal impairment in critically ill children.

Correction: Are we aware how contaminated our mobile phones with nosocomial pathogens?

Address: 1Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, 55139, Samsun, Turkey, 2Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, 55139, Samsun, Turkey and 3Department of Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, 55139, Samsun, Turkey

Do Erythrocyte Sedimentation Rate and C-Reactive Protein Levels Have Diagnostic Usefulness in Patients with Renal Failure?

Accessible online at: www.karger.com/journals/nef Dear Sir, Patients with chronic renal failure have a tendency to develop infectious and inflammatory disorders. On the other hand, there is no reliable serum marker for the diagnosis of infectious complications in these patients. Because of the conflicting reports, the validity of the two well-known acute-phase reactants, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), has not been determined clearly yet [1–4]. In order to evaluate the possible role of the acute-phase reactants in diagnosing and monitoring of inflammatory states, we studied ESR and CRP levels in uremic patients. The hemodialysis group consisted of 63 men and 52 women with a mean age of 44.6 B 1.3 (range 12–73) years. The mean duration of dialysis prior to entry into the study was 64.7 B 4.28 (range 3–175) months. The predialysis group included 19 men and 23 women. The mean age was 55.0 B 2.3 (range 25–86) years. There were 33 men and 42 women in the control group. The mean age was 43.8 B 1.7 (range 18–78) years. All the participitants were free from inflammatory signs within 1 month prior to study. As indicated in table 1, the basal ESR and CRP levels have been found to be higher in uremic patients without evidence of inflammation than the ones in controls. It seems that these parameters cannot be useful Table 1. Mean ESR and CRP levels in the study groups

Seroprevalence of hepatitis E in hemodialysis patients in Turkey.

Prof. Kuddusi Cengiz, MD, Department of Nephrology, Ondokuz Mayis University School of Medicine, TR-55139 Kurupelit, Samsun (Turkey) Dear Sir, Hepatitis E virus (HEV) and hepatitis C virus (HCV) seem to be the major causes of what was previously known as nonA, nonB hepatitis [1, 2]. HEV is mainly transmitted by the fecal-oral route and HCV by transfusion of blood products [3]. While chronic disease is common in HCV infection, HEV causes epidemic and sporadic hepatitis without the development of chronic liver disease. Cases of hepatitis E seem to occur in many developing countries. Possibly, HEV causes sporadic and silent cases of hepatitis E in industrialized countries. In this study, we investigated the prevalence of HEV antibodies in 72 patients with end-stage chronic renal failure on a maintenance hemodialysis program. These patients (30 women and 42 men, mean age 45.5 ± 1.8 years, range 17-70) were screened for hepatitis C virus antibody by third-generation enzyme-linked immu-nosorbent assay (micro-ELISA) (Organon Technica) and hepatitis E virus by macro-ELISA (Abbott). Their renal failure was due to chronic glomerulonephritis (25%), diabetes (19.5%), pyelonephritis (10%), amy-loidosis (14%), polycystic kidney disease (12.5%) and other etiologies (19%). The mean duration of time on hemodialysis was 4.7 ± 0.4 years (range 116). None of them had a history of acute hepatitis after the hemodialysis program. Their serum alanine aminotransferase levels were less than 1.5 times the upper normal limit (40 U/l). The control group consisted of 54 healthy volunteers (38 women and 16 men, mean age 46.5 ± 0.5 years, range 22-74). None of the healthy subjects showed HCV antibody and hepatitis B surface antigen. Thirty-five of 72 patients (48.6%) were anti-HCV-positive and 12 of 72 patients (16.7%) were Hbs Ag-positive. For the detection of IgG HEV antibodies, an ELISA test (Abbott, rDNA-antigen) was used. Ten of 72 patients (13.9%) were found to have positive IgG antibodies. This frequency was 5.5% in the control group. Among our HEV antibody-positive patients, 7 of 10 (70%) were also anti-HCV-positive and 3 of 10 (30%) were Hbs Ag-positive (2 patients were anti-HCV, anti-HEV IgG and Hbs Ag-positive). The prevalence of HEV antibody in patients on a maintenance hemodialysis program was higher than the control group (odds ratio 2.63; p < 0.01). The frequency in the control group was similar to the frequency of 5.9% reported in the Turkish population [4]. Our results in hemodialysis patients were similar to the 10.8% prevalence reported in 147 French hemodialysis patients [5].